Wednesday, February 27, 2013

The Bad News About Student Loan Disability Discharge

What the .....!

A few weeks ago I wrote about the challenges of chronic illness.  One of the challenges is financial hardships, from huge medical bills to a reduced income potential.  For me, personally, I am currently considered permanently disabled and unable to work due to the symptoms of my multiple chronic illnesses.

Despite my numerous efforts to "get better," I've been disabled for over 8 years now.

When I first became disabled in 2004 with the chronic pain and fatigue of fibromyalgia, I thought my former employer's short- and long-term disability insurances would kick in with disability income so I could keep paying all my bills.  I didn't know back then that the long term disability coverage would terminate after 2 years because it limited benefits for those diagnosed with fibromyalgia.

I appealed their decision, I went through the entire appeals process and was unable to get them to reverse their decision.

I found out the hard way that my safety net had a huge hole in it.  I went from earning a living to living on disability and taking a 61% pay cut. How to continue making my monthly student loan payments became one more boulder on a growing mountain of financial problems.

I was grateful in 2006 for the relief my student loan servicer offered.  I asked for a temporary disability forbearance, i.e., to be able to temporarily stop making my loan payments.  Back then I still hoped my situation might be temporary, that my doctors' would be able to get me back on my feet and working again.

To that end, I diligently followed my doctors' advice and complied with all the things they wanted me to do: take medications, go physical therapy, agree to trigger point injections, schedule deep injections and try acupuncture.

Time passed.  All those treatments my doctors prescribed failed to improve my symptoms.  I rapidly approached the 3 year time limit on requesting temporary disability forbearance. 

My next option with my student loan servicer was loan forgiveness due to total and permanent disability.  At first, I was almost reluctant to take this option, mostly because it seemed like a big declaration of "I'm not ever going to get better!"  But I felt like I had no choice; our budget was already lean and there wasn't any money for us to start making payments again.

This was a separate application process.  I needed to have my doctor complete a form verifying that I was permanently disabled.  Now that filled me with trepidation.  Have you ever needed to ask a doctor to put into writing that you are permanently disabled?  Because when you do, they look at you like you're asking them to admit they aren't able to help you.

Apparently doctors aren't good at stating the obvious.  My doctor initially balked when I asked her, despite the fact that there was absolutely no improvement in my symptoms or functioning over the past five years.  She only agreed after she asked if I was on Social Security Disability.  Somehow knowing I was on SSDI made it O.K. for her to say I was permanently disabled.

I got what I needed.  But to this day I just don't understand the moral dilemma my request presented her.

Now you don't get your loan forgiven overnight if you are totally and permanently disabled.  There is a 3 year conditional discharge waiting period.  Fortunately, student loan payments are suspended during this time.  

I was OK with waiting for 3 years, because if somehow I did improve and was able to work again, I would have gladly started repaying my loan again.  After all, it was my student loans that picked up all the school expenses that my part-time job didn't while I was in graduate school.  Those loans helped me earn a degree that launched my career in social work, a career that I really and truly miss.

At the beginning of last year it was crunch time.  My 3 year conditional discharge period was coming to an end.  There was some very important paperwork I needed to submit to my student loan servicer and I ran into some problems getting it faxed to them.  I needed to resort to snail mail, sent certified, to confirm it got to them.

After the anxiety of filing out forms, getting my doctor to say I was totally and permanently disabled and dotting the i's and crossing the t's on the final paperwork, I got word at the end of Spring 2012 that my disability discharge had been approved.  I thought my worries about my student loans were over.  Thank goodness!

Then I got a 1099-C form in the mail this past January from my student loan servicer.  I wasn't expecting it.  So I did some research and discovered that my discharged student loan debt was reported to the IRS as income.

I don't remember my student loan servicer ever telling me that my discharged loan would be considered income.

So we did our taxes early this year, cringing at the thought that we would owe the Feds and the state money this year.  Money we don't really have.

Sure enough, we have a whole new financial problem on our hands. We are straddled with a new debt, payable on April 15th, that will accrue interest and penalties if not paid on time.  So despite my best efforts, it feels like that mountain of financial problems only keeps getting bigger and bigger.

I guess the only "good" news is that my student loan debt is relatively small, at least compared to the woman featured in this article: New Jersey Woman's Student Loan Debt Creates Tax Nightmare.  And I am not alone in dealing with this; it's my spouse's income that will be getting us out of this latest pickle.

But what can all those other disabled workers with student loan debt like Kim do? How can they be expected to pay huge IRS tax bills when their earning potential is reduced and their savings are spent on medical bills?  Some of them don't even file a tax return because they now live below the poverty line.  Just imagine getting a horrid surprise from the IRS saying you owe taxes on income that, well, you didn't really get when your loan got forgiven!

I know the powers that be want to make defaulting on Federal student loans hard and painful.  In fact, student loans have historically been excluded from bankruptcy proceedings.  But I think you'll agree that when it comes to total and permanent disability there really needs to be some legislative reform on this issue.

This is completely unfair and burdensome to the disabled. (Yes, I know...life is unfair, yada yada, yada.)

At the very least, how about telling folks up front about the tax implications of loan forgiveness?  Or offering to help by spreading the "income" across several different tax years to make the tax burden more manageable?

My unsolicited advice for those of you going through this process RIGHT NOW: talk to a bankruptcy lawyer.  Ask them if you can get your student loans discharged through bankruptcy so you won't get hit with a huge tax bill you can't pay. Because I hate to say this, but depending on the size of your loans and resulting tax bill, you might be filing for bankruptcy anyway...  But hey, take this advice with a grain of salt, because I'm not a lawyer or a student loan servicer, so what do I know?

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Thursday, February 21, 2013

Did It Work? The Results of My Hepatitis C Treatment

This is me. Watch the video clip below
to learn if I'm now Hep C free.


Hi, it's Selena from the blog Oh My Aches and Pains! and I'm recording this message today because I have arrived the end of my Hepatitis C treatment journey.

I'm here today to share with you the results of my six month post-treatment Hepatitis C viral load. So drumroll please! I remain undetectable; the Hepatitis C virus cannot be found in my bloodstream. The treatment that I underwent was successful and I am currently Hepatitis C free.

Now part of me is ecstatic about this news, and part of me, I think, is dealing with a little bit of disbelief. I mean I have lived with Hepatitis C for 24 years so it's a little surreal to think that that, moving forward, I'm no longer dealing with a life with Hepatitis C. Now it might take a little bit of getting used to, but I think eventually I'll managed just fine.

I do need to let you know that there is a 0.8% chance that the virus could come back. Again, that is 0.8 percent, but I think you'll agree that chance is very small, tiny, miniscule. In fact, it's so small that there is a group of people in the medical community now, who considered an undetectable viral load at six month post-treatment a cure. Hey, I can deal with a cure!

I also have other good news to report. When I got my viral load test drawn, I also got an A1C test done, which is a test you do when you have diabetes. A normal test result is 5.9 or lower for people who aren't diabetic. My has resulted was 6.3 which is pretty darn good, especially considering how much Hepatitis C interfered with my ability to manage my diabetes. I've been living in 7+ range for quite a while now.

Every day I'm getting a little bit stronger and doing a little bit better. I'm still not back to my pre-treatment level of functioning, but I'm definitely better, much better, then I was six months ago. It might take another six month, or it could take up to two years post-treatment, for me to finally start feeling like I did before I started treatment.

In terms of my chronic pain and my chronic fatigue, unfortunately I haven't experienced any improvement in those symptoms. Maybe it's too early to tell…and it's possible Hepatitis C really didn't have much to do with those symptoms.

But either way, treating Hepatitis C was the right decision for me and I have now eliminated any possibility of developing any Hepatitis C related complications. And that's a good thing!

So now that my journey has ended and I've gotten a good outcome, it's time to celebrate! And since many of you who have been supporting me through this journey are online with me, we're going to have the party online. I'd like to do a Google hangout where we can all join in on a video chat. I'm putting together some party favors for those who are attending as well as some giveaways like I promised.

I just need a little bit of time to get everything together and then we can celebrate!

So if you're watching this, you're invited. Look for more information on my blog or on Facebook about actual day and time.

And once again I want to thank every one you who has reached out to me to offer me support during this journey. It has really helped me get where I am today. And I'm very honest when I say I couldn't have done this without your support. And now it's time for me to pay you back. So if you need my help, you know how to find me. Please don't hesitate to ask – I'm here to return the favor.

This has been Selena from the blog Oh My Aches and Pains! and I am now living life Hepatitis C free.

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Tuesday, February 12, 2013

Does Chronic Illness Mess With Your Emotions?

To be honest, I've been in a crummy mood lately.  There are a lot of reasons why, but I'm afraid if I use this post to list all the reasons, it is just going to reinforce the grumpiness.  So instead, I'm going to explore the connection between emotions and chronic illness, because I think being chronically ill can definitely mess with your emotions.

The Challenges of Chronic Illness

Let's start by looking at the daily challenges of living with chronic illness.  I think it comes down to seven main sources:
  1. the physical challenges that come from living in a body that doesn't working properly anymore
  2. the reduced physical and/or mental capabilities that are the direct result of being ill
  3. the stress and fatigue of living with it day-in and day-out
  4. the need to adapt to fluctuating health status and changing medical care
  5. all the financial challenges, like huge medical bills and a reduced income potential
  6. the repercussions on relationships with family and friends due to the above challenges
  7. the impact living with chronic illness has on your self-image and self-worth
Chronic illness can seem like an endlessly deep and dark pit I could easily get swallowed up by.

Some days I cope better; others days not so much.   That's when I use all the strategies at my disposal, like:
  • having fun every day
  • snuggling with my pets
  • getting lost in a good book, movie or TV show
  • heading out to my container garden
  • dabbling in arts and crafts
  • getting hugs and a kisses from my husband 
  • connecting with others--especially others living with chronic illness too

The truth is I'd love to just get well.  Or just get Zen enough to rise above my problems to a place where they don't touch me.  Even a brief vacation from my troubles would be nice.  Too bad none of these things are truly possible.

So I muddle through and do the best I can do, which I know sounds cliché, but then really, what other choice do I have if I want to still get some good things our of life?

An Avalanche of Emotions

No matter how well I cope, I am still faced with living a life filled with daily challenges.  At times, life with chronic illness can be very stressful and full of tension, fear and uncertainty. Living under this constant burden, a few emotions are bound to come up!

Some of the ones I've become very familiar with are:
  • helplessness
  • frustration
  • loneliness
  • hopelessness
  • sadness
  • resentment
  • irritability
  • anger

Most people would say these are "negative" emotions or feelings.  Personally, I don't like to label them this way because it makes harder for me to deal with them.  What serves me best is to acknowledge that all emotions need to be felt and experienced in the moment to make room for the other emotions that will come after them.

In other words, you won't be able to feel the "good" stuff if you avoid feeling the "bad" stuff.

An Increased Vulnerability to Stress

Adding insult to injury, I know many of us live with chronic pain and fatigue conditions that affect how our brains and nervous systems function.  Or should I say malfunction. Our chronic illnesses mess with our bodies' ability to regulate bodily functions like our hormones, neurotransmitters, immune response and sleep cycles.

In short, chronic illness makes us physically more susceptible to the adverse effects of stress.

I know when I get excited about something good happening or get worried about something bad, my body takes those impulses and completely blows them out of proportion.  My wonky nervous system gets thrown into the fight-or-flight response: my heart rate goes up, I get revved up, I'm jumpy, my muscles are more tense, my stomach is upset and I have more problems sleeping. While I can understand this kind of physical response in reaction to worry and stress, I am still taken aback when this happens as the result of hearing good news or anticipating something fun happening.  I mean, how strange is that?!?

Even with the use my coping tool box filled with reassuring self-talk, meditation, use of my emWave and distraction, my body doesn't always calm down.  Sometimes I am forced to just ride it out until the event, feelings or circumstance that trigger the response pass.  In the meantime, I take even better care of myself with more schedule rest, fewer strenuous activities and more time in quiet, calming surroundings.

Rising to the Challenge

As you can see, chronic illness impacts a person physically, mentally, emotionally, spiritually, socially and financially.

It presents a constant stream of daily challenges.  It keeps me on my toes, pushing me to learn, grown, change and adapt as I do my best to cope. It is the source of my bad pain and fatigue days, many unpleasant feelings and my occasional melancholy.

But I do my best to fight back most days, finding the small comforts and pleasures I can still enjoy that connect me to what life still has to offer me despite chronic illness.

But not today.  Today I'm feeling the yucky stuff so I can get to the happy stuff that is just around the corner.

So does chronic illness mess with your emotions too?  Leave me a comment and share your experiences with me and your fellow readers.

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Friday, February 8, 2013

The Final Steps in My Hepatitis C Treatment Journey

I'm nervous.  Or is it anxious?  Either way I am out-of-sorts and, quite frankly, I just want the next 10 days to fly by as quickly as possible.

You see, I go for my six month post Hepatitis C treatment blood work this weekend and apparently I am all freaked out about it.

This is the big one.  These are the lab results that tell me whether or not the treatment I got worked.  When I get the results, I learn if I have achieved something called SVR, which stands for "sustained virological response."  With the new antiviral drugs, like the drug Incivek that I took, the medical community to starting to consider SVR as the marker for a "cure."

Now that's pretty heady stuff.

I don't expect bad news.  My three month post-treatment viral load came back undetectable.  Since that test is a good predictor of the six month post-treatment results, I expect that this next result will be undetectable too.

But I don't want to take anything for granted.

It's weird when you live with a chronic, active infection for 25 years.  Hepatitis C became part of who I was in a lot of ways I hadn't really considered until recently.  Not that I want to keep living with it--no way, no how!

I don't want to be contemplating the worse case scenario either.  You all know that treatment was really difficult for me and I certainly do not want all my efforts to be in vain.  I can't even think about having to do it again without feeling massively discouraged.

Becoming Hepatitis C free is such a HUGE deal...and I really want this so badly.

My body knows this is a big deal and I can feel it responding to my anxiety by overreacting.  This is nothing new to me.  My dysfunctional brain goes into overload mode in the presence of any ongoing stimulation, be it good news or bad.  That translates into increased insomnia, sensory overload, worsening symptoms, tachycardia and general grumpiness, physically, mentally and emotionally.  Which is really just another day living with the ups and downs chronic illness.

Which leads me to the next thing I want to share with you today...

I really want to be able to say to you that, since Hep C treatment ended, I have seen improvements in my health now that my viral load is undetectable.  That just hasn't happened yet, and frankly, I'm a little concerned that it isn't going to happen either.

Honestly, given how much hope for improvement several of my medical providers pinned on a successful treatment outcome, I feel tremendously let down.

I still live with chronic, debilitating pain.  In fact, I have more pain now than when I was on treatment.  Weird, huh?  I'm not exactly sure what that means, but I do know that at one time low dose interferon was considered a treatment for fibromyalgia.  

I still deal with chronic, energy-sapping fatigue.  Not sure if that just means my body needs more time to heal from treatment or if Hep C wasn't the cause of my fatigue.

My blood sugar is better, but I still have type 2 diabetes and probably will for the rest of my life.

Plus I've learned some disappointing information.  Seems Hep C can trigger things like fibromyalgia since the little buggers can get into your brain.  They turn on a switch that makes things like chemical reactions and neurally-mediated pathways go all wonky.  Unfortunately, getting rid of Hep C virus doesn't flip the switch off according to rheumatologist Mark Borigini, M.D in an article over at Psychology Today.  Rude little buggers didn't turn the lights off when they vacated the premises!

And I am still dealing with three treatment-related complications that need continuing medical attention.  Quite frankly, I am getting quite annoyed with these linger health issues and I am ready to switch doctors yet again in an attempt to get these problems resolved once and for all.

Oh, and I am having a hard time getting a follow-up appointment with my new internal medicine doctor.  She's the one giving me the the results of the lab work I am having drawn this weekend.  A scheduling snafu is one more aggravation I don't need right now.

Thankfully I do have another doctor (actually her nurse) who I can email and ask for the results.  Because I would hate to have to wait, and wait, and wait to get these lab results.  Any delay is going to make me want to tear out my newly grown-in hair.

Huh.  I guess I really do have a lot of reasons to be feeling stressed out and short-tempered lately.

I need chocolate and lots of hugs and kisses.  Good thing Valentine's Day is next week, which gives me the perfect opportunity to request increased quantities of all of these.  Thank goodness I have folks in my life who can give me chocolate, hugs and kisses.  So I guess my life isn't that terrible after all.

I'll let you know the outcome of my Hep C treatment soon.  (In the meantime, excuse my typos and incoherence due to sleep deprivation.)

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Tuesday, February 5, 2013

Surviving Cold and Flu Season When You're Chronically Ill - Part One

Time flies when you are sick in bed!  January is over and I spent most of last month being sick with the flu or recovering from it. With this season's flu widespread in most states and an epidemic is some, I'm not the only one who has gotten or will get ill. So let me share with you my strategies for dealing with viral illnesses on top of my chronic ones.

Part One: Planning Ahead

Vaccines:  In the past, I have gotten both the yearly influenza and the one-time pneumococcal vaccination for the bacteria family that causes pneumonia, meningitis and septicemia.

I usually do O.K. with the influenza vaccine, except for one year when I developed a massive migraine headache afterwards.  That made me hesitant to get the shot the next year, so I skipped it.  I did muster up the courage to get vaccinated in 2011 and did O.K. once again.

This year, I was unable to get vaccinated in Fall 2012 for the current flu season because of other medical problems I was dealing with post Hepatitis C treatment.  Needless to say, once you get sick, getting the vaccine is pointless.

It is important to know that you should get vaccinated when you are feeling healthy and postpone the shot when you are sick.  There is a vaccine that is administered as a nasal spray that contains live virus (LAIV) and people living with certain health conditions like diabetes should not get this type of vaccination. Due to allergies and severe vaccine reactions, some people should not get vaccinated at all.  You can read more about flu shot precautions and contraindications at the CDC website.

Antiviral Medications:  There are antiviral medications available by prescription only to treat the flu.  They work best when taken within the first 48 hours of flu symptoms.  Which means you need to know what the symptoms of the flu are  and get in to see your doctor right away.  Better yet, talk to your doctor at the beginning of Fall, before flu season starts, and discuss having the medication, or a prescription for it, on hand just in case. Read more about antiviral medications for treating the flu at WebMD.

Sick Day Plan: If you live with diabetes, chances are your endocrinologist has already talked to you about developing a sick day plan.  This is also a good idea for the rest of us living with chronic illnesses too.  Creating a plan involves talking to your doctor about specific actions to take when you get sick.  Here are some question you might ask:
  • What symptoms are O.K. to treat with self-care at home and what symptoms need a doctor's attention?
  • What symptoms can be handled with a phone call and which ones need to be treated in the office, at the Urgent Care clinic or Emergency Room? 
  • What cold or flu remedies do I need to be avoided to prevent drug interactions?
  • Should I keep certain medications, like anti-nausea pills or suppositories, nasal sprays, inhalers and/or antiviral flu medication on hand?
  • Where should I go for medical care after-hours on the weekend and evenings?
Wash You Hands: The number one way to prevent getting the flu is to wash your hands, especially when you return from public places like the grocery store, restaurants and, yes, even your doctor's office.  The second is to train yourself not to touch you face with your hands, which is how the virus usually gets into your eyes, nose and mouth where it likes to hang out.

Stock Your Cupboards and Medicine Cabinet:  The last thing you want to do when you are sick is make a run to the drug or grocery store.  Make a point of checking on what cold remedies and fever reducers you have, especially the expiration dates, and make a list of what you need at the beginning of Fall.  You may also want to buy a stash of quick-to-prepare sick day foods like electrolyte replacement drinks, shelf-stable juices, tea, canned soups and crackers to have on hand as well.

Next time I'll discuss strategies for coping when you do get sick and how to get better as quickly as possible.

PLEASE NOTE:  The intent of this article is to provide general health education information and is not a substitute for professional medical advice.  When in doubt, consult your doctor for the care that is right for you.

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Friday, February 1, 2013

Where I Stand Today on Using Alternative Therapies to Treat Chronic Illnesses

I used to be a consumer of alternative health services like acupuncture, homeopathy, nutritional consultations, body work and chiropractic. I started using alternative therapies in 1995.  Back then, I had a lot of medical symptoms that I didn't feel were getting adequately addressed by my primary care doctor.  I shared my frustration with an acquaintance and he suggested I try seeing his chiropractor that was helping him live well with HIV.

What can I say? After that glowing review I had to try this approach too.  And try it I did for over 15 years.

 But then about two years ago I read the blog post Let Us All Praise Medical Woo and started feeling really stupid about spending so much money out-of-pocket on alternative health care.  That post made me realized that I got sucked into a branch of the healthcare system that appealed to my unmet medical needs but ultimately delivers little in the way of health in terms of care or results.

 So for the last two years I've given up seeing alternative health providers and the only thing I have really missed is the occasional chiropractic adjustment.  What I have gained is more money in my pocket, which has translated into fewer arguments with my spouse about our budget, or rather, my inability to stay within ours due to my medical-related expenses.

I've also stopped beat myself up for being so gullible.  Because heck, even the Federal government has allocated money to alternative medicine via the National Center for Complementary and Alternative Medicine (NCCAM). This agency is tasked with figuring out which alternative treatments really work in the hopes of making a difference in medical outcomes.

If you head over to their website and look under research results, you'll see a lot of reports with the word "may" in them, like this one: Acupuncture May Be Helpful for Chronic Pain: A Meta-Analysis. Not exactly a stamp of approval or scientific proof of effectiveness, but perhaps enough to convince someone desperate for pain relief to give acupuncture a try, even if their health insurance doesn't cover it.  Which is where the danger of alternative health lies.

In my experience, alternative health practitioners sell hope.  They do this by convincing patients that they can get better if they pay for treatments, herbs, supplements and nutritional advice over the course of months and even years.  But there are few scientific studies that support the notion that alternative treatments can treat or cure specific diseases or illnesses. When it comes to embracing the hope that alternative therapies seem to offer, I know I'm not alone.  In the United States, consumers spent $34 BILLION dollars out-of-pocket on things like acupuncture, therapeutic touch and nutritional supplements in 2009.

By the way, I do still take nutritional supplements, some of the same ones that were recommend and sold to me by the alternative health practitioners I used to see.  But now, I skip the expense of an office visit to get these products "prescribed" to me. 

In retrospect, none of the alternative health professionals I saw claimed to treat or cure any of the specific illnesses I had.  When I first starting seeing them in the mid-1990's, they spoke to me a lot about enhancing my well-being and returning my body back to a state of health.  But after I started living with chronic pain and fatigue in 2004, and it started becoming clear that their treatments weren't really helping, some of them got as frustrated as I was about how I wasn't getting any better.

So some decided to ramped up their efforts, which only made me feel worse, not better.  That made it easy for me to decide stop seeing them.  Others blamed my use of medications--the ones prescribed by my doctors--as the barrier to achieving wellness, even after I explained how they were helping me manage my illnesses.  When it was suggested I need to cut back or stop them, I decided it was time to stop the alternative health treatments that weren't helping me instead.

Between the expense and the lack of results, it was easy for me to finally stop all alternative treatments about two years ago.

With the benefit of time and distance, I've come to see using alternative medicine to treat chronic illness as similar to putting a bandage on a deep puncture wound. I think it's the wrong-sized treatment for your health problems. When you are chronically ill, you don't need health enhancement, you need to regain your health.  From where I stand now, I just don't think alternative health practices can do that.

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